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  • Question 1 - Which of the following is a likely consequence of severe diarrhoea? ...

    Correct

    • Which of the following is a likely consequence of severe diarrhoea?

      Your Answer: A decrease in the sodium content of the body

      Explanation:

      Diarrhoea can occur due to any of the numerous aetiologies, which include infectious, drug-induced, food related, surgical, inflammatory, transit-related or malabsorption. Four mechanisms have been implicated in diarrhoea: increased osmotic load, increased secretion, inflammation and decreased absorption time. Diarrhoea can result in fluid loss with consequent dehydration, electrolyte loss (Na+, K+, Mg2+, Cl–) and even vascular collapse. Loss of bicarbonate ions can lead to a metabolic acidosis.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      14
      Seconds
  • Question 2 - A 6 year old boy is brought to the ER after being hit...

    Correct

    • A 6 year old boy is brought to the ER after being hit by a car. He is hemodynamically unstable with bilateral femoral shaft fractures and a suspicion of splenic rupture. Despite having thoroughly explained the risks, the parents have refused blood transfusions and any invasive measures on account of religious beliefs. What would be the most appropriate response by the physician?

      Your Answer: Proceed with treatment

      Explanation:

      In an emergency, where consent cannot be obtained, doctors should provide medical treatment that is in the patient’s best interests and is immediately necessary to save a life or avoid significant deterioration in the patient’s health. There is clearly insufficient time here to apply to a court. The GMC and common law advises that emergency life saving treatment can be given to a child irrespective of the parents views.

    • This question is part of the following fields:

      • Management And Legal Issues In Surgery
      • Principles Of Surgery-in-General
      1805
      Seconds
  • Question 3 - Whilst snorkelling, a 30-year old gentleman has the respiratory rate of 10/min, tidal...

    Correct

    • Whilst snorkelling, a 30-year old gentleman has the respiratory rate of 10/min, tidal volume of 550 ml and an effective anatomical dead space of 250 ml. Which of the following will bring about a maximum increase in his alveolar ventilation?

      Your Answer: A 2x increase in tidal volume and a shorter snorkel

      Explanation:

      Alveolar ventilation = respiratory rate × (tidal volume − anatomical dead space volume). Increase in respiratory rate simply causes movement of air in the anatomical dead space, with no contribution to the alveolar ventilation. By use of a shorter snorkel, the effective anatomical dead space will decrease and will cause a maximum rise in alveolar ventilation along with doubling of tidal volume.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      38
      Seconds
  • Question 4 - What is the likely diagnosis in a 55-year old man presenting with jaundice,...

    Correct

    • What is the likely diagnosis in a 55-year old man presenting with jaundice, weight loss, pale coloured stools and elevated alkaline phosphatase?

      Your Answer: Pancreatic carcinoma

      Explanation:

      Increased alkaline phosphatase is indicative of cholestasis, with a 4x or greater increase seen 1-2 days after biliary obstruction. Its level can remain elevated several days after the obstruction is resolved due to the long half life (7 days). Increase up to three times the normal level can be seen in hepatitis, cirrhosis, space-occupying lesions and infiltrative disorders. Raised alkaline phosphatase with other liver function tests being normal can occur in focal hepatic lesions like abscesses or tumours, or in partial/intermittent biliary obstruction. However, alkaline phosphatase has several isoenzymes, which originate in different organs, particularly bone. An isolated rise can also be seen in malignancies (bronchogenic carcinoma, Hodgkin’s lymphoma), post-fatty meals (from the small intestine), in pregnancy (from the placenta), in growing children (from bone growth) and in chronic renal failure (from intestine and bone). One can differentiate between hepatic and non-hepatic cause by measurement of enzymes specific to the liver e.g. gamma-glutamyl transferase (GGT).
      In an elderly, asymptomatic patient, isolated rise of alkaline phosphatase usually points to bone disease (like Paget’s disease). Presence of other symptoms such as jaundice, pale stools, weight loss suggests obstructive jaundice, most probably due to pancreatic carcinoma.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      193.4
      Seconds
  • Question 5 - The periphery of a haematoma is infiltrated by fibroblasts, collagen and new vasculature....

    Incorrect

    • The periphery of a haematoma is infiltrated by fibroblasts, collagen and new vasculature. This process is best described as?

      Your Answer: Recanalization

      Correct Answer: Organisation of the haematoma

      Explanation:

      Formation of granulation tissue at the periphery of the hematoma is a normal process leading to resolution. This granulation tissue is composed of new capillaries, fibroblasts and collagen. Lysis of a blood clot can occur, but the actual process of this response is known as organization, wherein the scar tissue will become part of the vessels. This is followed by recanalization and embolization which can lead to eventual complications. Proliferation of a clot will occur due to an imbalance in the clotting and lysing systems. Thrombosis has nothing to do with the process described above.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      11.3
      Seconds
  • Question 6 - A 16-year old boy was brought in an unconscious state to the emergency...

    Correct

    • A 16-year old boy was brought in an unconscious state to the emergency department. Clinical evaluation pointed in favour of acute adrenal insufficiency. On enquiry, it was revealed that he was suffering from a high grade fever 24 hours prior. On examination, extensive purpura were noted on his skin. The likely diagnosis is:

      Your Answer: Meningococcaemia

      Explanation:

      Findings described are suggestive of Waterhouse-Friderichsen syndrome which develops secondary to meningococcaemia. The reported incidence of Addison’s disease is 4 in 100,000. It affects both sexes equally and is seen in all age groups. It tends to show clinical symptoms at the time of metabolic stress or trauma. The symptoms are precipitated by acute infections, trauma, surgery or sodium loss due to excessive perspiration.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      67
      Seconds
  • Question 7 - A 56 year old man presents to the emergency with a type IIIc...

    Incorrect

    • A 56 year old man presents to the emergency with a type IIIc Gustilo and Anderson fracture of distal tibia after being involved in a road traffic accident. He was trapped under the wreckage for about 7 hours and had been bleeding profusely from the fracture site during this time. He is found to have an established neurovascular deficit. Which of the following is the most appropriate course of action?

      Your Answer: Insertion of intramedullary nail and arterial reconstruction

      Correct Answer: Amputation

      Explanation:

      A below-knee amputation (“BKA”) is a transtibial amputation that involves removing the foot, ankle joint, and distal tibia and fibula with related soft tissue structures. In general, a BKA is preferred over an above-knee amputation (AKA), as the former has better rehabilitation and functional outcomes. There are three major categories of indications for proceeding with a BKA. These include:
      – Urgent cases where source control of necrotizing infections or haemorrhagic injuries outweighs limb preservation.
      – Less acutely, urgent BKAs may be performed for chronic nonhealing ulcers or significant infections with the risk of impending systemic infection or sepsis.
      – Urgent BKAs may be performed where limb salvage has failed to preserve a mangled lower extremity. Adequate resuscitation and stabilization must always have occurred before such a decision, as judged by vital signs, lactate, base deficit, and the management of concomitant injuries.
      This man is hemodynamically unstable and the limb is likely to be non-viable after so many hours of entrapment. Hence, the safest option would be primary amputation of the injured limb.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
      14.6
      Seconds
  • Question 8 - A 45-year-old man complains of shortness of breath, cough and chest pain. Chest...

    Incorrect

    • A 45-year-old man complains of shortness of breath, cough and chest pain. Chest X ray revealed a perihilar mass with bronchiectasis in the left mid-lung. Which of the following is most probably associated with these findings?

      Your Answer: Pulmonary hamartoma

      Correct Answer: Bronchial carcinoid

      Explanation:

      Bronchial carcinoids are neuroendocrine tumours that arise from Kulchitsky’s cells of the bronchial epithelium. Kulchitsky’s cells belong to the diffuse endocrine system. Patients affected by this tumour may be asymptomatic or may present with symptoms of airway obstruction, like dyspnoea, wheezing, and cough. Other common findings are recurrent pneumonia, haemoptysis, chest pain and paraneoplastic syndromes. Chest radiographs are abnormal in the majority of cases. Peripheral carcinoids usually present as a solitary pulmonary nodule. For central lesions common findings include hilar or perihilar masses with or without atelectasis, bronchiectasis, or consolidation. Bronchial carcinoids most commonly arise in the large bronchi causing obstruction.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      22
      Seconds
  • Question 9 - A 34 year old man arrives at the clinic due to a painless...

    Incorrect

    • A 34 year old man arrives at the clinic due to a painless lump in his left teste. His blood tests and US point towards a teratoma. Which of the following is the most appropriate next step in the management of this patient?

      Your Answer: Core biopsy of the lesion

      Correct Answer: Orchidectomy via an inguinal approach

      Explanation:

      Unlike other cancers for which a biopsy is performed, when testicular cancer is suspected the entire testicle is removed in a procedure called an orchiectomy through an incision in the groin and pulling the testicle up from the scrotum. A biopsy through the scrotum for testicular cancer runs the risk of spreading the cancer, and can complicate future treatment options. Removing the entire testicle out of the scrotum is the only safe way to diagnose for testicular cancer. Only the cancer-containing testicle is removed, and it is important to do so promptly.
      If there is any uncertainty, the urologists can examine the testicle by pulling the testicle out of the scrotum; if a condition other than testis cancer is found, the testicle is placed back into the scrotum.

      Testicular cancer is the most common malignancy in men aged 20-30 years. Around 95% of cases of testicular cancer are germ-cell tumours.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Urology
      26.9
      Seconds
  • Question 10 - A 54 year old man fell off his bicycle. He felt a severe...

    Correct

    • A 54 year old man fell off his bicycle. He felt a severe pain in his hand and wasn't able to move it. It was found that a carpal bone in the distal row was fractured. Which is the most likely bone?

      Your Answer: Trapezium

      Explanation:

      There are eight carpal bones which are arranged in two rows, proximal and distal; scaphoid, lunate, triquetral and pisiform are of proximal row. Trapezium, trapezoid, capitate and hamate are of the distal row.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      13
      Seconds
  • Question 11 - A 43 year old construction worker is rushed to the A&E department after...

    Correct

    • A 43 year old construction worker is rushed to the A&E department after complaining of chest pain after an episode of severe vomiting. He was found to be in shock. What would be his diagnosis?

      Your Answer: Boerhaave’s syndrome

      Explanation:

      Boerhaave syndrome refers to an oesophageal rupture secondary to forceful vomiting and retching. They are often associated with the clinical triad (Mackler’s triad) of vomiting, chest pain and subcutaneous emphysema. Other symptoms include epigastric pain, back pain, dyspnoea and shock. This condition was universally fatal before the age of surgery.

      Ideal management for Boerhaave syndrome involves a combination of both conservative and surgical interventions.

      Mainstays of therapy include the following:
      – Intravenous volume resuscitation
      – Administration of broad-spectrum antibiotics
      – Prompt endoscopic and/or surgical intervention

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Upper Gastrointestinal Surgery
      10.6
      Seconds
  • Question 12 - Which of the following foramina will the ophthalmic artery pass through in order...

    Incorrect

    • Which of the following foramina will the ophthalmic artery pass through in order to reach the eye?

      Your Answer: Foramen spinosum

      Correct Answer: Optic canal

      Explanation:

      The optic foramen is the opening to the optic canal. The canal is located in the sphenoid bone; it is bounded medially by the body of the sphenoid and laterally by the lesser wing of the sphenoid. The superior surface of the sphenoid bone is bounded behind by a ridge, which forms the anterior border of a narrow, transverse groove, the chiasmatic groove (optic groove). The groove ends on either side in the optic foramen, which transmits the optic nerve and ophthalmic artery into the orbital cavity. Compared to the optic nerve, the ophthalmic artery is located inferolaterally within the canal.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      9.5
      Seconds
  • Question 13 - A 33 year old morbidly obese women is considered for bariatric surgery. Which...

    Correct

    • A 33 year old morbidly obese women is considered for bariatric surgery. Which of the options provided below would most likely be associated with the highest long term failure rates?

      Your Answer: Intra gastric balloon

      Explanation:

      The intragastric balloon aids weight loss by slowing the rate at which food enters the stomach and by stimulating gastric stretch receptors. But lifestyle changes, including behaviour modification, exercise and a healthy diet, are crucial for maintaining weight loss once the device is removed. Intragastric balloon is really only suitable as a bridge to a more definitive surgical solution and is associated with a high failure rates and complications.

      Gastric banding: band applied to upper stomach which can be inflated or deflated with normal saline. This affects satiety. Over a 5 year period complications requiring further surgery occur in up to 15% cases.

      Roux-en-Y gastric bypass: a gastric pouch is formed and connected to the jejunum. Patients achieve greater and more long-term weight loss than gastric banding.

      Sleeve gastrectomy: body and fundus resected to leave a small section of stomach

    • This question is part of the following fields:

      • Generic Surgical Topics
      • Upper Gastrointestinal Surgery
      11.4
      Seconds
  • Question 14 - Lack of findings in the bladder but presence of atypical epithelial cells in...

    Incorrect

    • Lack of findings in the bladder but presence of atypical epithelial cells in urinalysis is most often associated with which of the following conditions?

      Your Answer: Nodular glomerulosclerosis

      Correct Answer: Transitional cell carcinoma of renal pelvis

      Explanation:

      The presence of atypical cells in urinalysis without findings in the bladder suggests a lesion located higher up, most probably in ureters or renal pelvis. Transitional cell cancer of the renal pelvis is a disease in which malignant cells form in the renal pelvis and is characterised by the presence of abnormal cells in urine cytology.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      67.6
      Seconds
  • Question 15 - A 40 year old man suffered severe trauma following an MVA. His BP...

    Incorrect

    • A 40 year old man suffered severe trauma following an MVA. His BP is 70/33 mmhg, heart rate of 140 beats/mins and very feeble pulse. He was transfused 3 units of blood resulting in his BP returning to 100/70 and his heart rate to 90 beats/min. What decreased following transfusion?

      Your Answer: Stroke volume

      Correct Answer: Total peripheral resistance

      Explanation:

      The patient is in hypovolemic shock, he is transfused with blood to replace the volume lost. It is important not only to replace fluids but stop active bleeding in resuscitation. Fluid replacement will result in a decreased sympathetic discharge and adequate ventricular filling thus reducing total peripheral resistance and increasing cardiac output and cardiac filling pressures.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
      8.5
      Seconds
  • Question 16 - A 49-year-old male patient is recovering from a right hemicolectomy for Crohn's disease....

    Incorrect

    • A 49-year-old male patient is recovering from a right hemicolectomy for Crohn's disease. He is oliguric and dehydrated owing to a high output ileostomy. His electrolytes are normal. Out of the following, which intravenous fluid should be administered?

      Your Answer: 0.9% sodium chloride

      Correct Answer: Hartmann's solution

      Explanation:

      Hartmann’s solution is the preferred fluid among the listed options.

      In UK, Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients (GIFTASUP) and The National Institute for Health and Care Excellence (NICE) guidelines were devised to try and develop a consensus on how to administer intravenous fluids (IV) postoperatively. A decade ago, it was a commonly held belief that little harm would occur as a result of excessive administration of normal saline, and many oliguric postoperative patients received enormous quantities of IV fluids. As a result, they developed hyperchloraemic acidosis. With greater understanding of this potential complication, the use of electrolyte-balanced solutions (Hartmann’s or Ringer Lactate solution) is now favoured over normal saline.

      The guidelines further include:
      1. Fluids given should be documented clearly.
      2. Assess the patient’s fluid status when they leave the theatre.
      3. If the patient is haemodynamically stable and euvolaemic, aim to restart oral fluid intake as soon as possible.
      4. If the patient is oedematous, hypovolaemia if present should be treated first. This should then be followed by a negative balance of sodium and water, monitored closely.
      5. Solutions such as Dextran 70 should be cautiously used in patients with sepsis as there is a risk of developing acute renal injury.

    • This question is part of the following fields:

      • Post-operative Management And Critical Care
      • Principles Of Surgery-in-General
      29.3
      Seconds
  • Question 17 - A 17-year-old boy, who had developed shortness of breath and a loss of...

    Incorrect

    • A 17-year-old boy, who had developed shortness of breath and a loss of appetite over the last month, was referred to a haematologist because he presented with easy bruising and petechiae. His prothrombin time, platelet count, partial thromboplastin and bleeding time were all normal. Which of the following would explain the presence of the petechiae and easy bruising tendency?

      Your Answer:

      Correct Answer: Scurvy

      Explanation:

      Scurvy is a condition caused by a dietary deficiency of vitamin C, also known as ascorbic acid. Humans are unable to synthesize vitamin C, therefore the quantity of it that the body needs has to come from the diet. The presence of an adequate quantity of vitamin C is required for normal collagen synthesis. In scurvy bleeding tendency is due to capillary fragility and not coagulation defects, therefore blood tests are normal.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds
  • Question 18 - A 45 years old women was diagnosed with breast cancer. After a radical...

    Incorrect

    • A 45 years old women was diagnosed with breast cancer. After a radical mastectomy to remove all axillary lymph nodes from her right breast, it was noticed that she had a winged scapula. Which nerve injury would explain this?

      Your Answer:

      Correct Answer: Long thoracic nerve

      Explanation:

      The long thoracic nerve supplies the serratus anterior muscle. When this nerve is injured the muscle undergoes paralysis, which is seen clinically as winging of the scapula most apparent when the arm is lifted forward. The long thoracic nerve is greatly susceptible to injury during breast surgery because of its long and superficial course along the thorax from its origin, the brachial plexus, to the lower border of the serratus anterior muscle.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds
  • Question 19 - A 20-year old cyclist falls off a speeding bike and fractures a structure...

    Incorrect

    • A 20-year old cyclist falls off a speeding bike and fractures a structure that articulates with the tubercle of the 7th rib. Which structure is fractured?

      Your Answer:

      Correct Answer: Transverse process of vertebra T7

      Explanation:

      A rib tubercle is a projection that is postero-inferior and lateral to the neck of a rib which articulates with the transverse process of the corresponding vertebra i.e. of the same number. Therefore, the tubercle of rib 7 articulates with the transverse process of T7 vertebra. The head of the rib 7, on the other hand, articulates with the 6th vertebra superiorly and the 7th vertebra inferiorly.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds
  • Question 20 - The thyrocervical trunk branches into which artery that passes upward and in front...

    Incorrect

    • The thyrocervical trunk branches into which artery that passes upward and in front of the vertebral artery and longus colli muscle:

      Your Answer:

      Correct Answer: Inferior thyroid

      Explanation:

      The inferior thyroid artery is an artery in the neck. It arises from the thyrocervical trunk and passes upward, in front of the vertebral artery and longus colli muscle.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds
  • Question 21 - Which of the following structures is affected or damaged when the 'anterior drawer...

    Incorrect

    • Which of the following structures is affected or damaged when the 'anterior drawer test' is positive?

      Your Answer:

      Correct Answer: Anterior cruciate ligament

      Explanation:

      The anterior drawer test is an important orthopaedic test that is used to test weakness of the anterior cruciate ligament. The test is done by having the patient sit in a supine position with his/her knees flexed at 90 degrees. An examiner stabilises the patients feet and softly pulls or pushes on the proximal tibia. The test is positive if there is translational movement of the tibia in relation to the femur, indicating a weakened anterior cruciate ligament. The anterior cruciate ligament prevents the tibia from sliding out in front of the femur.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds
  • Question 22 - The vascular structure found on the right side of the fifth lumbar vertebra...

    Incorrect

    • The vascular structure found on the right side of the fifth lumbar vertebra is?

      Your Answer:

      Correct Answer: Inferior vena cava

      Explanation:

      The most likely vascular structure is the inferior vena cava. The inferior vena cava is formed by the joining of the two common iliac arteries, the right and the left iliac artery, at the level of the fifth lumbar vertebra( L5). The inferior vena cava passes along the right side of the vertebral column. It enters the thoracic cavity into the underside of the heart through the caval opening of the diaphragm at the level of the eight thoracic vertebra (T8).

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
      0
      Seconds
  • Question 23 - A 29-year-old woman is due to undergo a laparoscopic cholecystectomy. Which of the...

    Incorrect

    • A 29-year-old woman is due to undergo a laparoscopic cholecystectomy. Which of the following intra-abdominal pressures should typically be set on the gas insufflation system?

      Your Answer:

      Correct Answer: 10 mmHg

      Explanation:

      A pressure of 10 mmHg should be set on the gas insufflation system.

      Laparoscopic surgery may be performed in a number of body cavities. In some areas, irrigation solutions are preferred. In the abdomen, however, insufflation with carbon dioxide gas is commonly used. The amount of gas delivered is adjusted to maintain a constant intra-abdominal pressure of 12–15 mmHg. Excessive intra-abdominal pressure may reduce venous return and lead to hypotension. Too little insufflation will risk obscuring the surgical view.

    • This question is part of the following fields:

      • Principles Of Surgery-in-General
      • Surgical Technique And Technology
      0
      Seconds
  • Question 24 - A 35 year old man presented to the surgical OPD with a lump...

    Incorrect

    • A 35 year old man presented to the surgical OPD with a lump on his right forearm which appeared 3 weeks ago and was tender on examination. He gave a history was being in a car accident with pieces of glass from the windshield piercing his forearm removed manually and on further elective surgery. Which of these cells are characteristically found during inflammation in this situation?

      Your Answer:

      Correct Answer: Giant cell

      Explanation:

      A foreign body reaction Is characteristic of giant cells. Glass being the foreign object initiates an inflammatory response in this condition.
      Mast cells are involved in allergic reactions.
      Eosinophils are characteristic of a parasitic infection and allergic inflammatory process but are not due to foreign bodies.
      Plasma cells are typical of chronic inflammation.
      Lymphocytes are involved in viral infections.
      Macrophages combine together to form giant cells.

    • This question is part of the following fields:

      • Basic Sciences
      • Pathology
      0
      Seconds
  • Question 25 - A 1 day old baby girl is born with severe respiratory compromise. She...

    Incorrect

    • A 1 day old baby girl is born with severe respiratory compromise. She is seen to have a scaphoid abdomen and an absent apex beat. Which anomaly does this baby have?

      Your Answer:

      Correct Answer: Bochdalek hernia

      Explanation:

      Answer: Bochdalek hernia

      A Bochdalek hernia is one of two forms of a congenital diaphragmatic hernia, the other form being Morgagni hernia. A Bochdalek hernia is a congenital abnormality in which an opening exists in the infant’s diaphragm, allowing normally intra-abdominal organs (particularly the stomach and intestines) to protrude into the thoracic cavity. In the majority of patients, the affected lung will be deformed, and the resulting lung compression can be life-threatening. Bochdalek hernias occur more commonly on the posterior left side (85%, versus right side 15%).

      In normal Bochdalek hernia cases, the symptoms are often observable simultaneously with the baby’s birth. A few of the symptoms of a Bochdalek Hernia include difficulty breathing, fast respiration and increased heart rate. Also, if the baby appears to have cyanosis (blue-tinted skin) this can also be a sign. Another way to differentiate a healthy baby from a baby with Bochdalek Hernia, is to look at the chest immediately after birth. If the baby has a Bochdalek Hernia it may appear that one side of the chest cavity is larger than the other and or the abdomen seems to be scaphoid (caved in).

      Situs inversus (also called situs transversus or oppositus) is a congenital condition in which the major visceral organs are reversed or mirrored from their normal positions. The normal arrangement of internal organs is known as situs solitus while situs inversus is generally the mirror image of situs solitus. Although cardiac problems are more common than in the general population, most people with situs inversus have no medical symptoms or complications resulting from the condition, and until the advent of modern medicine it was usually undiagnosed. In the absence of congenital heart defects, individuals with situs inversus are homeostatically normal, and can live standard healthy lives, without any complications related to their medical condition. There is a 5–10% prevalence of congenital heart disease in individuals with situs inversus totalis, most commonly transposition of the great vessels. The incidence of congenital heart disease is 95% in situs inversus with levocardia.

      Cystic fibrosis is a progressive, genetic disease that causes persistent lung infections and limits the ability to breathe over time. In people with CF, mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene cause the CFTR protein to become dysfunctional. When the protein is not working correctly, it’s unable to help move chloride — a component of salt — to the cell surface. Without the chloride to attract water to the cell surface, the mucus in various organs becomes thick and sticky. In the lungs, the mucus clogs the airways and traps germs, like bacteria, leading to infections, inflammation, respiratory failure, and other complications.

      Necrotizing enterocolitis (NEC) is a medical condition where a portion of the bowel dies. It typically occurs in new-borns that are either premature or otherwise unwell. Symptoms may include poor feeding, bloating, decreased activity, blood in the stool, or vomiting of bile.
      The exact cause is unclear. Risk factors include congenital heart disease, birth asphyxia, exchange transfusion, and premature rupture of membranes. The underlying mechanism is believed to involve a combination of poor blood flow and infection of the intestines. Diagnosis is based on symptoms and confirmed with medical imaging.

      Morgagni hernias are one of the congenital diaphragmatic hernias (CDH), and is characterized by herniation through the foramen of Morgagni. When compared to Bochdalek hernias, Morgagni hernias are:
      -anterior
      -more often right-sided (,90%)
      -small
      -rare (,2% of CDH)
      -at low risk of prolapse

      Only ,30% of patients are symptomatic. New-borns may present with respiratory distress at birth similar to a Bochdalek hernia. Additionally, recurrent chest infections and gastrointestinal symptoms have been reported in those with previously undiagnosed Morgagni hernia.
      The image of the transverse colon is herniated into the thoracic cavity, through a mid line defect and this indicates that it is a Morgagni hernia since the foramen of a Morgagni hernia occurs in the anterior midline through the sternocostal hiatus of the diaphragm, with 90% of cases occurring on the right side.

      Clinical manifestations of congenital diaphragmatic hernia (CDH) include the following:

      Early diagnosis – Right-side heart; decreased breath sounds on the affected side; scaphoid abdomen; bowel sounds in the thorax, respiratory distress, and/or cyanosis on auscultation; CDH can often be diagnosed in utero with ultrasonography (US), magnetic resonance imaging (MRI), or both
      Late diagnosis – Chest mass on chest radiography, gastric volvulus, splenic volvulus, or large-bowel obstruction
      Congenital hernias (neonatal onset) – Respiratory distress and/or cyanosis occurs within the first 24 hours of life; CDH may not be diagnosed for several years if the defect is small enough that it does not cause significant pulmonary dysfunction
      Congenital hernias (childhood or adult onset) – Obstructive symptoms from protrusion of the colon, chest pain, tightness or fullness the in chest, sepsis following strangulation or perforation, and many respiratory symptoms occur.

    • This question is part of the following fields:

      • Generic Surgical Topics
      • The Abdomen
      0
      Seconds
  • Question 26 - A 25-year-old woman hits her head on the steering wheel during a collision...

    Incorrect

    • A 25-year-old woman hits her head on the steering wheel during a collision with another car. She is brought to the A&E department with periorbital swelling and a flattened appearance of the face. What is the most likely injury?

      Your Answer:

      Correct Answer: Le Fort III fracture affecting the maxilla

      Explanation:

      The flattened appearance of the face is a classical description of the dish-face deformity associated with Le Fort III fracture of the midface.

      The term Le Fort fractures is applied to transverse fractures of the midface involving the maxillary bone and surrounding structures in either a horizontal, pyramidal, or transverse direction. There are three grades of Le Fort fractures:

      1. Le Fort I
      It is the horizontal fracture of the maxilla. Violent force over a more extensive area above the level of the
      teeth will result in this type of fracture. Horizontal fracture line is seen above the apices of the maxillary teeth, detaching the tooth-bearing portion of the maxilla from the rest of the facial skeleton. Floating maxilla and Guerin’s sign is seen in such patients.

      2. Le Fort II
      It is a pyramidal or subzygomatic fracture. Violent force in the central region extending from glabella to the alveolus results in this type of fracture, resulting in ballooning or moon-face facial deformity.

      3. Le Fort III
      It is a high-level transverse or suprazygomatic fracture associated with craniofacial disjunction. The entire facial skeleton moves as a single block as a result of the trauma. The patient develops a characteristic panda facies and dish-face deformity.

    • This question is part of the following fields:

      • Emergency Medicine And Management Of Trauma
      • Principles Of Surgery-in-General
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  • Question 27 - An old woman complains of a lack of sensation halfway down the anterior...

    Incorrect

    • An old woman complains of a lack of sensation halfway down the anterior surface of the thigh. The cause of this:

      Your Answer:

      Correct Answer: Would result from damage to the nerve that innervates the pectineus muscle

      Explanation:

      The pectineus is supplied by the second, third and fourth lumbar nerves through the femoral nerve and by the third lumbar through the accessory obturator when it exists. The anterior surface of the thigh receives its innervation from the femoral nerve as well, thus this is the nerve most likely to be injured

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 28 - A 70-year old man had had a large indirect inguinal hernia for 3...

    Incorrect

    • A 70-year old man had had a large indirect inguinal hernia for 3 years. He presents at the out patient clinic complaining of pain in the scrotum. There is, however, no evidence of obstruction or inflammation. You conclude that the hernial sac is most probably compressing the:

      Your Answer:

      Correct Answer: Ilioinguinal nerve

      Explanation:

      The ilioinguinal nerve arises together with the iliohypogastric nerve from the first lumbar nerve to emerge from the lateral border of the psoas major muscle just below the iliohypogastric and passing obliquely across the quadratus lumborum and iliacus muscles. It perforates the transversus abdominis, near the anterior part of the iliac crest and communicates with the iliohypogastric nerve between the internal oblique and the transversus. It then pierces the internal oblique to distribute filaments to it and accompanying the spermatic cord through the subcutaneous inguinal ring, is distributed to the skin of the upper and medial parts of the thigh, the skin over the root of the penis and the upper part of the scrotum in man and to the skin covering the mons pubis and labium majus in the woman. As the ilioinguinal nerve runs through the inguinal canal, it could easily be compressed by a hernial sac.
      The femoral branch of genitofemoral nerve provides sensory innervation of the upper medial thigh.
      The femoral nerve innervates the compartment of the thigh and also has some cutaneous sensory branches to the thigh.
      The iliohypogastric nerve innervates the skin of the lower abdominal wall, upper hip and upper thigh. The subcostal nerve innervates the skin of the anterolateral abdominal wall and the anterior scrotal nerve is a terminal branch of the ilioinguinal nerve.

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 29 - A patient had sudden complete loss of vision of the right eye. Fundoscopy...

    Incorrect

    • A patient had sudden complete loss of vision of the right eye. Fundoscopy showed the distinct cherry red spot on the retina. Which of the following arteries was occluded?

      Your Answer:

      Correct Answer: Central artery of the retina

      Explanation:

      The central retinal artery supplies all the nerve fibres that form the optic nerve, which carries the visual information to the lateral geniculate nucleus of the thalamus. Thus if the central retinal artery gets occluded, there is complete loss of vision in that eye and the entire retina (with the exception of the fovea) becomes pale, swollen and opaque while the central fovea still appears reddish (this is because the choroid colour shows through). This is the basis of the famous Cherry red spot seen on examination of the retina on fundoscopy of a central retinal artery occlusion (CRAO).

    • This question is part of the following fields:

      • Anatomy
      • Basic Sciences
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  • Question 30 - A 7-year-old girl is given cephalexin to treat an infection and develops hives,...

    Incorrect

    • A 7-year-old girl is given cephalexin to treat an infection and develops hives, with localised facial oedema. Which of the following conditions will cause localised oedema?

      Your Answer:

      Correct Answer: Angio-oedema

      Explanation:

      Angio-oedema, is the rapid swelling of the skin, mucosa and submucosal tissues. The underlying mechanism typically involves histamine or bradykinin. The version related to histamine is to due an allergic reaction to agents such as insect bites, food, or medications. The version related to bradykinin may occur due to an inherited C1 esterase inhibitor deficiency, medications e.g. angiotensin converting enzyme inhibitors, or a lymphoproliferative disorder.

    • This question is part of the following fields:

      • Basic Sciences
      • Physiology
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SESSION STATS - PERFORMANCE PER SPECIALTY

Basic Sciences (8/9) 89%
Physiology (2/2) 100%
Management And Legal Issues In Surgery (1/1) 100%
Principles Of Surgery-in-General (3/3) 100%
Pathology (3/3) 100%
Generic Surgical Topics (3/4) 75%
Urology (1/1) 100%
Anatomy (3/4) 75%
Upper Gastrointestinal Surgery (1/2) 50%
Surgical Technique And Technology (1/1) 100%
The Abdomen (1/1) 100%
Emergency Medicine And Management Of Trauma (1/1) 100%
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